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Updated: Jan 15, 2026
Dynamic Visual Tests to Identify and Quantify Visual Damage and Repair Following Demyelination in Optic Neuritis Patients
Published on: April 14, 2014
The impact of adding optical coherence tomography in MS diagnostic criteria on the classification of tumefactive
Fiorella S Guido1, John J Chen2, Paul A Decker3
1Department of Neurology, Mayo Clinic, Rochester, MN, USA; Center for Multiple Sclerosis and Autoimmunen Neurology, Mayo Clinic, Rochester, MN, USA.
Background:
De novo tumefactive demyelination (TD) poses a diagnostic challenge, with lower rates of cerebrospinal fluid (CSF) oligoclonal bands and lower female-to-male ratio than typical onset multiple sclerosis (MS). Only about half fulfill the 2017 McDonald diagnostic criteria for MS at presentation. Therefore, our aim was to assess optic nerve involvement by optical coherence tomography (OCT) in patients with TD. Further, whether the presence of abnormalities on OCT would allow additional TD patients to be diagnosed with MS when the optic nerve is added as a fifth topography to the Barkhof criteria or 2017 McDonald criteria.
Methods:
Observational retrospective chart review of patients seen at a tertiary referral center from 1/1/1990 to 2/21/2024 with TD. Inclusion criteria were: 1) brain MRI showing an active TD lesion; 2) medical records with at least one available clinical assessment by a neurologist; 3) available Cirrus OCT data to review. Exclusion criteria were: 1) patients with final diagnosis of vasculitis, abscess, CNS malignancies, or MOGAD; 2) presence of confounding ocular disease.
Results:
OCT was available in 68 patients with TD. The tumefactive attack was the first demyelinating event in 45 (67 %) patients. At presentation, 29/68 (43 %) fulfilled 3 of 4 Barkhof criteria, and 34/68 (50 %) fulfilled the 2017 McDonald criteria for the diagnosis of MS. A clinical history of optic neuritis was present in 9/68 (13 %) patients and OCT was abnormal in 9/9 (100 %) of those patients. Regardless of clinical history, OCT was abnormal in 22/68 (32 %) patients. Therefore, OCT identified abnormalities suggestive of prior optic neuritis in 13/59 (22 %) TD patients without a clinical history of optic neuritis. If the optic nerve, as a firth topography, was assessed by OCT 39/68 (57 %) would fulfill McDonald criteria.
Conclusions:
OCT in patients presenting with TD lesions can frequently identify both clinical and subclinical optic neuritis. The addition of the optic nerve as a fifth topography assessed by OCT to fulfill dissemination in space criteria would allow additional TD patients to be diagnosed with MS.
Insights
Optical coherence tomography (OCT) can detect optic nerve damage in tumefactive demyelination (TD) patients, aiding in multiple sclerosis (MS) diagnosis. Adding optic nerve assessment via OCT to diagnostic criteria helps identify more TD cases as MS.
Area of Science:
- Neuroscience
- Ophthalmology
- Radiology
Background:
- Tumefactive demyelination (TD) presents diagnostic challenges, often with atypical features compared to typical multiple sclerosis (MS).
- Fewer TD patients meet standard MS diagnostic criteria at initial presentation.
- Assessing optic nerve involvement may improve MS diagnosis in TD cases.
Purpose of the Study:
- To evaluate optic nerve involvement using optical coherence tomography (OCT) in patients with TD.
- To determine if OCT findings can help diagnose additional TD patients with MS by incorporating the optic nerve into diagnostic criteria.
Main Methods:
- Retrospective chart review of 68 TD patients from a tertiary referral center.
- Inclusion criteria: active TD lesion on MRI, neurologist assessment, available OCT data.
- Exclusion criteria: other neurological conditions (e.g., MOGAD), confounding ocular diseases.
Main Results:
- 50% of TD patients met 2017 McDonald MS criteria at presentation; OCT identified abnormalities in 32% regardless of clinical history.
- OCT detected subclinical optic neuritis in 22% of TD patients without a prior clinical history.
- Including the optic nerve assessed by OCT as a fifth topography would allow 57% of TD patients to meet McDonald criteria for MS.
Conclusions:
- OCT is valuable for identifying clinical and subclinical optic neuritis in TD patients.
- Incorporating OCT-assessed optic nerve topography aids in diagnosing TD patients with MS.
- This approach enhances the application of dissemination in space criteria for MS diagnosis.
